The Effect of Surgical Experience on Perioperative and Oncological Outcomes After Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Evidence from a Referral Centre with Extensive Experience in Robotic Surgery

Dell’Oglio, Paolo; Mazzone, Elio; Lambert, E. Warren; Vollemaere, Jonathan; Goossens, M.; Larcher, Alessandro; Jeugt, J. Van Der; Devos, Gaëtan; Poelaert, Filip; Uvin, Pieter; Collins, Justin; Naeyer, Geert De; Schatteman, Peter; D’Hondt, Frederiek; Mottrie, Alexandre

doi:10.1016/j.euf.2020.01.016

Cited by 40 publications

(23 citation statements)

References 20 publications

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“…With regard to the team composition, the data suggested a steep improvement in console surgeon performance (expressed as the console duration) with the progression of surgical experience after taking into account the degree of abdominal adhesions. This is in line with previous data reporting that experienced console surgeons have a steep learning curve even for technically demanding procedures, e.g., 20-30 cases for radical cystectomy [23,24]. As such, these data seem to expand the applicability of a steep learning curve in experienced surgeons to include very rarely performed procedures.…”

Section: Discussionsupporting

confidence: 90%

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

Buse

Alexandrov²,

Mazzone

et al. 2021

BMC Urol

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Background Simultaneous urothelial cancer manifestation in the lower and upper urinary tract affects approximately 2% of patients. Data on the surgical benchmarks and mid-term oncological outcomes of enbloc robot-assisted radical cystectomy and nephro-ureterectomy are scarce. Methods After written informed consent was obtained, we prospectively enrolled consecutive patients undergoing enbloc radical cystectomy and nephro-ureterectomy with robotic assistance from the DaVinci Si-HD® system in a prospective institutional database and collected surgical benchmarks and oncological outcomes. Furthermore, as one console surgeon conducted all the procedures, whereas the team providing bedside assistance was composed ad hoc, we assessed the impact of this approach on the operative duration. Results Nineteen patients (9 women), with a mean age of 73 (SD: 7.5) years, underwent simultaneous enbloc robot-assisted radical cystectomy and nephro-ureterectomy. There were no cases of conversion to open surgery. In the postoperative period, we registered 2 Clavien-Dindo class 2 complications (transfusions) and 1 Clavien-Dindo class 3b complication (port hernia). After a median follow-up of 23 months, there were 3 cases of mortality and 1 case of metachronous urothelial cancer (contralateral kidney).The total operative duration did not decrease with increasing experience (r = 0.174, p = 0.534). In contrast, there was a significant, inverse, strong correlation between the console time relative to the total operative duration and the number of conducted procedures after adjusting for the degree of adhesions and the type of urinary diversion(r = -0.593, p = 0.02). Conclusions These data suggest that en bloc simultaneous robot-assisted radical cystectomy and nephro-ureterectomy can be safely conducted with satisfactory mid-term oncological outcomes. With increasing experience, improved performance was detectable for the console surgeon but not in terms of the total operative duration. Simulation training of all team members for highly complex procedures might be a suitable approach for improving team performance. Trial registration: Not applicable.

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Section: Discussionsupporting

confidence: 90%

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

Buse

Alexandrov²,

Mazzone

et al. 2021

BMC Urol

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“…Faraj et al. illustrated a significant increase in PSMs with higher pT‐stages, but in contrast Dell’Oglio could not find an association between surgical experience and PSMs 6,28 . According to our results, experienced surgeons had a higher OR of 3.06 for PSMs in the multiple regression analysis, which is clearly counterintuitive.…”

Section: Discussioncontrasting

confidence: 86%

“…Like other interventions, the outcomes of RARC are influenced by a learning curve. According to the International Robotic Cystectomy Consortium (IRCC), acceptable results can be achieved after 30 cases for all urinary diversions, whereas an ongoing decrease of complications has recently been illustrated even after 60 intracorporeal urinary diversions (ICUD) 5,6 . However, RARC is no everyday intervention, which explains why the learning curve is long 7 …”

Section: Introductionmentioning

confidence: 99%

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Zeuschner

Linxweiler

Mohr

et al. 2021

Robotics Computer Surgery

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Background Most comparisons of robot‐assisted (RARC) versus open radical cystectomy (ORC) for urothelial carcinoma do not factor the inherent stage selection bias or surgical experience. Methods We compared the perioperative outcomes of 229 RARC and 335 ORC at a single tertiary referral centre with propensity score matching and multiple regression models, when controlling for tumour and patient characteristics, surgeon's experience and type of urinary diversion. Results RARC had less major complications (19.8% vs. 34.1%) and ICU admissions (6.6% vs. 19.8%), with lower blood loss (400 vs. 500 ml) and transfusion rates. The operating time was longer (336 vs. 286 min), but decreased with surgeon's experience. RARC had less positive surgical margins (3% vs. 8.4%) and a higher lymph node count (14 vs. 11). Conclusions In this large single centre series comparing RARC with ORC controlling for stage selection bias and surgical experience, RARC proved significantly better outcomes, especially with intracorporeal urinary diversion.

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“…LRC with ICUD is a complex procedure [ 41 ]. Due to the limitations of laparoscopy in regard to reconstructive interventions, there is little experience in the field of ICUD, with few cases published in the literature [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Table 4 ).…”

Section: Discussionmentioning

confidence: 99%

Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

Andraș

Territo

Telecan³

et al. 2021

JCM

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(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.

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The Effect of Surgical Experience on Perioperative and Oncological Outcomes After Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Evidence from a Referral Centre with Extensive Experience in Robotic Surgery

Cited by 40 publications

References 20 publications

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

Surgical benchmarks, mid-term oncological outcomes, and impact of surgical team composition on simultaneous enbloc robot-assisted radical cystectomy and nephroureterectomy

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

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